To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Aggressive Diabetes Management Prevents Heart Surgery Complication URL: http://www.pslgroup.com/dg/526EE.htm Doctor's Guide January 26, 1998
NEW ORLEANS, LA -- January 26, 1998 -- Short-term post-operative monitoring and control of blood glucose in people with diabetes after heart surgery greatly reduces the risk of a life-threatening complication known as a deep sternal wound infection, according to a study presented today at The Society of Thoracic Surgeons Annual Meeting in New Orleans. Cardiothoracic surgeon Anthony Furnary, MD, and colleagues from the Providence St. Vincent Medical Center in Portland, OR. studied the link between blood glucose control and the risk of deep sternal wound infection development to document health and mortality outcomes for people with diabetes recovering from open heart surgery. "The incidence of deep sternal wound infections in patients with diabetes can be significantly decreased by the [use] of a continuous intravenous insulin infusion protocol which aggressively eliminates post-operative hyperglycemia [or high blood sugar]," the authors write. "Postoperative hyperglycemia in diabetic patients may be effectively managed through the [use] of insulin infusion designed to keep blood glucose (200 mg/dl). "This study reconfirms our previous finding that hyperglycemia in the first two postoperative days is significantly associated with, and an independent predictor of, deep sternal wound infection." None of the 494 cardiac surgery patients with diabetes receiving insulin infusion under the Portland Continuous Intravenous Insulin Protocol since August 1996 have suffered a deep sternal wound infection. The significant conclusion of this study is that the control of blood glucose levels can minimise a highly lethal surgical complication among people with diabetes in an acute care surgical environment. While numerous studies have highlighted the role of blood sugar control via insulin therapy as a means to reduce diabetes complications, this analysis is one of the first to conclusively document benefits of blood glucose control in an acute care surgical environment. One unexpected finding was that those who received the continuous insulin infusion therapy had a lower overall mortality rate after heart surgery. While numerous factors could contribute to this finding, the author's data suggests that postoperative hyperglycemia not only predisposed the patient with diabetes to infection, but it also may contribute to a patient's mortality during surgical recovery independent of infectious complications. Further investigations are underway by Dr. Furnary to determine if use of continuous insulin infusion eliminates a risk to a patient's well-being in an acute care surgical setting. The medical and related costs of deep sternal wounds are staggering. Patients with diabetes who develop this complication stand a five-fold greater risk of dying, are hospitalised an average of 16 days longer than non-infected patients, and generate an estimated $26,400 in additional hospital bills. Dr. Furnary adds, "While the measurable costs of deep sternal wounds are disturbing, the pain, suffering and loss of life from a potentially-preventable condition is even more worrisome," Dr. Furnary said. "If the diabetes treatment protocol used in our study was widely implemented, countless lives could be saved and the livelihood of many Americans would be improved." Through their research, the authors compared the incidence of deep sternal wound infection in two groups. Consisting of 1499 patients with diabetes, the surgeons treated the study group with a continuous infusion of intravenous insulin in the operating room and in the postoperative environment to control blood glucose levels. The 968 members of the control group were treated by intermittent intravenous insulin in the operating room, while in the postoperative environment these patients with diabetes were placed on traditional subcutaneous insulin therapy to control blood glucose levels. The therapies were assigned to people with diabetes undergoing heart surgery regardless of prior insulin use. However, people in the study group had a greater predisposition to deep sternal wound infections due to a higher incidence of associated risk factors. Specifically, the study group was more likely to be obese, have hypertension, use steroids for the control of other health conditions and have an increased need for internal thoracic artery grafts while undergoing coronary artery bypass surgery (CABG). Despite this negative bias, the study group had a significantly lower incidence of deep sternal wound infection. In fact, the study group's risk actually mirrored the accepted risk in the non-diabetes population. The authors note that if the continuous insulin therapy described in their research had been instituted in all cardiac operations during 1996, approximately 1950 deep sternal wounds could have been prevented and 372 patient lives could have been saved. Ultimately this technique could have saved $51.7 million in reduced hospital costs alone during 1996. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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